Provider Demographics
NPI:1427030659
Name:JACOBSON, IRA JOEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:JOEL
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7431-33 WEST ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-3505
Mailing Address - Country:US
Mailing Address - Phone:561-496-6900
Mailing Address - Fax:561-496-5348
Practice Address - Street 1:7431-33 WEST ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-3505
Practice Address - Country:US
Practice Address - Phone:561-496-6900
Practice Address - Fax:561-496-5348
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP00001689213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL03288OtherWELLCARE ID
FL029691100Medicaid
FL4623420002Medicare NSC
U05245Medicare UPIN
FL03288OtherWELLCARE ID
FL029691100Medicaid